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Regional nerve blocks key to delivering quality dental care


DVM360 MAGAZINE



Photo 9B: This view is from the lingual aspect of the mandible to demonstrate the mandibular foramen for the caudal mandibular block.

Feline anatomical differences


Photo 10: Radiopaque dye infused local anesthetic mixture placed at the level of the mandibular canal for the caudal mandibular block to demonstrate the extensive diffusion along the mucosa/bone interface.
Anatomical differences between species require slight variations in technique when considering nerve blocks in cats. When performing the rostral maxillary (infraorbital) nerve block in cats, the approach is the same as described in the dog, but the infraorbital foramen is relatively more dorsal in the cat. Therefore, the needle should be inserted more dorsally and then advanced in a rostral-to-caudal direction into the infraorbital foramen. As in the dog, the needle should not engage bone and should pass directly into the foramen.


Photo 11: The arrow shows the infraorbital foramen in the cat. Please note that it is only a few millimeters in length.
The infraorbital canal in cats is much shorter, and the foramen relatively larger than that found in the dog (Photo 11). Because the canal is only a few millimeters long, administration of the agent into the canal places it adjacent to the infraorbital and pterygopalatine nerves. This results in creating the same effect as the caudal maxillary nerve block in dogs. In this discussion, it is suggested that the single nerve block for the cat maxilla be termed the maxillary nerve block since it is performed as is the rostral maxillary block in dogs but blocks the same region as the caudal maxillary block.


Figure 12: The arrow demonstrates the location of the middle mental foramen, the landmark for needle introduction in the rostral mandibular block in the cat.
Cats have no mandibular first and second premolars; therefore the middle mental foramen in the cat is located midway between the mandibular canine and third premolar (Photo 12). Only in very small cats is this foramen not accessible to needle placement for administration of the rostral mandibular block. If one encounters difficulty, the caudal mandibular block is an alternative.

Concluding thoughts

Regional nerve blocks for oral surgery are valuable tools in enhancing patient safety intraoperatively and patient comfort postoperatively. They are easy to administer and require no special equipment to perform. Their use encourages quick return to normal mastication and continuation of normal food and water intake shortly after oral procedures. Incorporation of oral regional nerve blocks into the dentistry service is paramount in providing the best in patient care. Simplification and clarification of nomenclature should be considered to eliminate confusion between descriptions of actual anatomical regions and the nerves themselves.

Brett Beckman, DVM, FAVD, Dipl. AVDC practices referral dentistry at Affiliated Veterinary Specialists, Orlando, Fla.; Noah's Animal Hospitals in Indianapolis; and at Florida Veterinary Dentistry and Oral Surgery in Punta Gorda, Fla. He is president-elect of the American Veterinary Dental Society and diplomate of the American Academy of Pain Management.

REFERENCES

  • Rochette J: Local Anesthetic Nerve Blocks and Oral Analgesia, in Proceedings from the 26th World Congress of the World Small Animal Veterinary Association, August 2001; 250-252.
  • Haws IJ: Local Dental Anesthesia, in Proceedings from the 13th Annual Veterinary Dental Forum, October 1999; 304-307.
  • Holmstrom SE, Frost P, Eisner ER: Veterinary Dental Techniques. Philadelphia, W.B. Saunders, 1998; 492-493.
  • Beckman BW, Legendre L. Regional nerve blocks for oral surgery in companion animals. Comp Cont Ed Prac Vet 2002; 24:439-44.
  • Mama KR. Local Anesthetics. In: Gaynor JS, Muir W W. Handbook of Veterinary Pain Management. St. Louis: Mosby, 2002; 232.
  • Bazin JE, Massoni C, Bruelle P, Fenies V, Groslier D, Schoeffler P: The addition of opioids to local anesthetics in brachial plexus block: the comparative effects of morphine, buprenorphine and sufentanil. Anaesthesia. 1997 52(9):858-62
  • Candido KD, Winnie AP, Ghaleb AH, Fattouh MW, Franco CD: Buprenorphine added to the local anesthetic for axillary brachial plexus block prolongs postoperative analgesia. Reg Anesth Pain Med; 2002 27(2):162-7
  • Niedfeldt RL, Robertson SA. Postanesthetic hyperthermia in cats: A retrospective comparison between hydromorphone and buprenorphine. Vet Anaesth Analg. 33:381-389, 2006.
  • Posner LP, Hollis, N Luders JW: Post anesthetic hyperthermia in cats. Vet Anaesth Analg. 34:40-47, 2007.


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